Introduction to Public

Health
Human Biology III
Lesson 1

Yeetey Enuameh MD, MSc DrPH

Email: yeetey@yahoo.com
Outline of lesson
1. Defining public health
2. The mission of public health
3. The focus of public health
4. Some key terms in public health
5. Some important areas of public health
6. Brief history of public health
7. A public health approach
8. Core sciences in public health
9. Core functions and essential services in public health
 1. Defining Public Health
•The science and art of preventing
disease, prolonging life, and promoting
health and efficiency through organized
community efforts for the sanitation of
the environment, the control of
communicable infections, the education
of the individual in personal hygiene, the
organization of medical and nursing
services for the early diagnosis and
preventive treatment of disease, and the
development of the social machinery to
insure everyone a standard of living
adequate for the maintenance of health
(Charles-Edward Amory Winslow, 1920)

Winslow CEA. The untilled field of public health. Mod Med 1920;2:183–91.
Defining Public Health
• The science and art of preventing disease,
prolonging life, and promoting health through
organized efforts of society
– a summary of Winslow’s definition in the Acheson Report on Health Inequalities in
the UK (1988).

• Public Health is one of the efforts organized by

society to protect, promote, and restore the
peoples’ health
– John Last (2001).
2. The Mission of Public Health

“Fulfilling society’s interest in

assuring conditions in which people
can be healthy.”
—National Academy of Medicine, 1998

“Public health aims to provide

maximum benefit for the largest
number of people.”
—World Health Organization
3. The Focus of Public Health
• Public health focuses on groups of people, rather
than just an individual.
• It focuses on the health of the population in totality,
rather than medical healthcare, which focuses on
treatment of the individual ailment
• At the core of public health lies the principle of
social justice, providing people the right to be
healthy and to live in conditions that will support
their health.
 Social Justice
• Social justice implies:
• Equal rights, opportunity and treatment for all
• https://www.sdfoundation.org/news-events/sdf-news/what-is-social-justice/
• Fair treatment of all in society i.e., justice in terms of the distribution of
wealth, opportunities, and privileges within a society
• https://www.lexico.com/en/definition/social_justice
• Principles of social justice
• Equity
• Fair distribution of available resources for all in society
• Access
• All have access to goods and services regardless of race, gender, religion, age or
any other social classes
• Participation
• All participate in decisions that influence their lives
• Rights
• Protecting individual liberties to information about circumstances and decisions
affecting them and to appeal decisions that are unfair to people
4. Some Key Terms of Public Health
• Clinical care
• Prevention, treatment, and management of illness and the
preservation of mental and physical well-being through the
services offered by medical and allied health professions; also
known as health care.
• Personal health
• Individual actions and decisions (preventive or curative) that
affect the health of an individual or their immediate family
members
• Determinant
• Factor that contributes to the generation of a trait/outcome.
• Health outcome
• Result of a medical condition that directly affects the length
or quality of a person’s life.
Some Key Terms of Public Health
• Epidemic or outbreak
• Occurrence in a community or region of cases of an illness, specific
health-related behavior, or other health-related event clearly in
excess of normal expectancy.
• Both terms are used interchangeably; however, epidemic usually
refers to a larger geographic distribution of illness or health-related
events.
• Pandemic
• Denoting a disease affecting or attacking the population of an
extensive region, country, or continent.
• Intervention
• Action or ministration that produces an effect or is intended to alter
the course of a pathologic process.
• Disease prevention
• A process consisting of specific population and individual based
interventions aimed at minimizing the burden of disease and
associated risk factors.
 Some key terms of Public Health
• Global health
• An area for study, research and practice that places a
priority on improving health and achieving health equity for
all people worldwide (Koplan et al., 2009)
• Population health
• the actions and conditions to promote, protect and
preserve the health of persons that are not organized, do
not necessarily have an identity as a group or locality.
• International health
• A branch of public health that deals with prevention in
populations and clinical care of individuals other countries
other than one’s own, especially those of low-and middle-
income countries
 5. Some important areas of public
health
• Community health
• involves the identification of needs, the promotion, protection,
preservation and improvement of the collective health of a
“defined group” of people through the combined efforts of both
government (public) and private health agencies
• Environmental health
• A branch of public health concerned with all aspects of the
natural and built environments that may affect human health
• Behavioral health
• The scientific study of the emotions, behaviors and biology
relating to a person’s mental well-being, their ability to function
in everyday life and their concept of self
• “Behavioral health” is preferred to the term “mental health”
• Occupational health
• Safety, health and well-fare of people at work
Community health
• A major field in the study of medical and clinical sciences
that focuses on the maintenance, protection and
improvement of the health status of population groups
and communities as opposed to the health of individual
patients
• A community is
• A group of people brought together by some common
characteristics such as location, race, ethnicity, age, occupation,
interest in particular problems or outcomes or share common
bonds
• Community health concerns itself with the study and
improvement of health characteristics of communities
• Community health in the past focused on geographical
areas rather than people with shared characteristics
Other areas of study in public health
• Aging
• Biomedical lab sciences
• Biostatistics
• Chronic diseases
• Clinical research
• Communication sciences
and disorders
• Dental public health
• Epidemiology
• Exercise science
• Food safety
• Genetics
• Health education/behavioral
sciences
• Health law
• Health promotion and
communication
• Health services research
• Immunology
• Infectious diseases
• Informatics
• Injury /violence
• Management and health
policy
• Maternal and child health
Other areas of study in public health
• Social determinants of health
• Substance use/harm reduction
• Toxicology
• Tropical medicine
• Veterinary public health
• Women’s health
• Public health ethics
• Public health leadership
• Public health medicine
• Public health policy
• Public health practice
• Minority health and health
disparities
• Multicultural studies
• Neuroscience
• Nutrition/public health nutrition
• Parasitology
• Population and reproductive
health
• Population sciences
• Preparedness, response and
recovery
• Risk assessment
• Global health
• Health administration
• Health economics/ health
finance
 6. History of Public Health
• Some activities have over the years influenced health
outcomes of populations
• The history of Public health can be looked at through the
lenses of such activities
• They include:
• Sanitation and environmental health
• Pandemics
• Disaster response and preparedness
• Prevention and policy.
• Public health works to protect and improve health, not
just by responding to disease outbreaks or preparing for
natural or human-made disasters, but also by
implementing policies that support these efforts on a
societal level.
6a. Sanitation and Environmental Health
• Disease control and health promotion from the
perspective of sanitation to ensure a healthy
environment
• Historical examples of public health approaches used in
containing infectious diseases through environmental
measures
• Ancient Greeks and Romans actively practiced community
sanitation measures [500 BC]
• The United Kingdom in 1848 passed the Public Health Act
that provided a central board of health and placed
responsibilities for sanitation in the hands of boroughs
• The Environmental Protection Agency was established by the
Nixon administration in the United States in 1970 to protect
human health by safeguarding air, water and land
 6b. Pandemics
• Pandemics are epidemics affecting the populations of multiple
continents. Public health has been instrumental in the control of
influenza, polio, HIV, Ebola-virus disease and recently COVID-19.
• Influenza [the flu], has caused pandemics over the course of history.
• Almost a century ago, the Spanish flu infected 500 million people across the world, killing 20 to
50 million persons.
• The influenza pandemic of 2009 infected persons in 214 countries resulting in 19,000 confirmed
deaths.
• Influenza control will likely remain a top priority for public health in years ahead.
• Polio historically caused severe illness, including paralysis, and death among
thousands of people each year.
• The polio vaccine was introduced in 1955
• a polio eradication initiative was launched in 1988 due to outbreaks in more than 125 countries
• Polio today exists in only a few countries.
• The human immunodeficiency virus [HIV] emerged and spread rapidly across
the globe in the 1980s.
• Public health over the years developed new ways to diagnose and treat those infected by the
condition.
• Public health interventions have been successful with reductions in new infections and
management of existing ones.
 6c. Preparedness for Disaster Response
• Public health has been instrumental in the preparedness
and response to both natural disasters and human-made
threats.
• After the September 11, 2001, terror attacks, public health
workers conducted surveillance for disease outbreaks and
possible health conditions attributable to the attacks.
• The health of first responders, city residents, and environmental
conditions were monitored by public health personnel to detect
health threats during the cleanup after the attack.
• Public health workers and other disaster-relief agencies provided
emergency services after Hurricane Katrina in 2005.
• Surveillance was also maintained for illness and injury among persons
evacuated to shelters and other places of refuge.
• Public health personnel were greatly involved in the control and
management of the West African Ebola Virus Disease outbreak
in 2014 and the recent COVID-19 .
 6d. Prevention through Policy
• Policies that support disease prevention and health
promotion in society
• The first believed written health code in the world dates as far
back as 1500 BC in Leviticus [the third book of the Hebrew
Bible]. Personal and community responsibilities for a healthy
life are elucidated there.
• Laws banning smoking in the workplace and other public places
have been developed to encourage smokers to quit while
protecting nonsmokers from the effects of second-hand smoke.
• Efforts to highlight fat, sugar, and salt content in foods through
labeling regulations have been developed along with the
promotion of physical activity in schools, workplaces, and
neighborhoods to combat obesity.
• Seat belt use in vehicles and road use regulations are some
policies to protect from road traffic accidents.
• Mask wearing, sanitizing, etc. during the COVID-19 period
7. A Public Health Approach to addressing health issues

• Public health problems are diverse and can include:

• infectious diseases
• chronic diseases
• Emergencies
• Injuries
• environmental health problems
• other health threats
• Regardless of the health issue at stake, we take the
same approach to a public health problem by
following four general steps.
7. A Public Health Approach – the four steps

• The four steps of the public health approach:

1. First, we ask “What is the problem?”
• In public health, surveillance systems are employed for problem
identification i.e., to monitor health events and behaviors
occurring in a population.
2. After we have identified the problem, the next question
is, “What is the cause of the problem?”
• These identify factors that might make certain populations more
susceptible to disease
• E.g., something in the environment or certain behaviors of the
population contributing to the identified problem.
3. We look at what has worked in the past in addressing a
similar problem, and if a proposed intervention suites
the context of the affected population.
4. In the last step, we ask, “How can we implement the
intervention? Given the resources we have and what we
know about the affected population, will this work?”
 A Public Health Approach

Risk Factor Intervention

Surveillance Implementation
Identification Evaluation

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 Applying a Public Health Approach – Cholera

• Cholera, a fatal intestinal

disease, was rampant
during the early 1800s in
London, causing death to
tens of thousands of
people in the area.
• Cholera was commonly
Photo: TJ Kirn, MJ Lafferty, CMP Sandoe, and R Taylor,
thought to be caused by
Dartmouth Medical School
bad air from rotting
organic matter.

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 Applying a Public Health approach - John Snow

▪ John Snow, a British Physician is best

known for his work tracing the source of
the cholera outbreak.
▪ He is considered the father of modern
epidemiology.
▪ He believed that the illness was spreading
by way of a contaminated water supply
because sewage was routinely dumped into
Photo: London School of Hygiene and
Tropical Medicine
the Thames River and cesspools near town
wells.
▪ His research changed the way we look at
disease.
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Applying a Public Health approach — What is the Problem?

Cluster of Cholera Cases, London — 1854

• The neighborhood in question [red
circle] and the black dots represent
the deaths from cholera. Higher
density of deaths were around Broad
Street.
• A local clergyman, Reverend Henry
Whitehead, assisted Snow in tracking
down and interviewing cholera victims
and their families and geographically
mapping the outbreak.
• Their efforts highlight the benefits of
linking scientific inquiry with
engagement of community
stakeholders and shared ownership for
health.
Image: The Geographical Journal

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Applying a Public Health approach — What Is the Cause?
Risk factor identification - Cluster of Cholera Cases and Pump Site Locations

• Snow identified risk factors by

determining the cause of the deaths
using the pattern of where cases were
occurring.
• The largest number of cholera cases
were in the location of the water
pumps [black boxes].
• He further identified where people
who had cholera were drawing their
water, observing that clusters of
cholera cases were more commonly
located around certain pumps,
particularly the Broad Street pump.
• Snow therefore concluded that
drawing water from the Broad Street
pump was a primary risk factor for
becoming ill with cholera.
Image: The Geographical Journal

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Applying a Public Health approach — What Works?

• Intervention evaluation
• After having identified the risk factors
• Snow through continuous research, understood that
interventions required to control the outbreak of
cholera were to:
• stop exposure to the contaminated water supply on a
larger scale, and
• stop exposure to the entire supply of contaminated water
in the area
Applying a Public Health approach — How Do You Do It?
Intervention implementation
• Snow’s intervention was to remove the handle
from the Broad Street pump, so no one could
continue to draw water from the contaminated
water supply.
• After a long battle with the politicians in
government and water companies, he finally
convinced them that water contaminated with
sewage was the source of cholera and other
diseases.
• This led to the implementation of policies and
laws for water sanitation.
Photo: Justin Cormack

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. Core sciences in Public Health

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 Core sciences in Public Health
• To implement the public health approach, practitioners use
and apply scientific methods from a series of core sciences
that include
1. Epidemiology - helps determine where diseases originate, how or
why they move through populations, and how they can be
prevented.
2. Public Health Surveillance - monitoring a public health situation.
3. Public Health Laboratories - perform tests to confirm disease
diagnoses. They also facilitate the conduct of research and
training.
4. Public Health Informatics is gaining more importance with the
transition from paper to electronic records. It deals with the
methods for collecting, compiling, and presenting health
information, enabling the use electronic data effectively to address
public health situations.
5. Prevention Effectiveness is closely linked to public health policy.
Prevention effectiveness studies provide important economic
information for decision makers to help them choose the best
option available.
9. Core Functions and Essential Services of Public Health

• Public health has three core functions

• Each of these core functions have essential public
health services that help their actualization
• Overall, there are ten essential public health
services that help address the three core functions.
• These functions and services serve as a descriptive
tool to capture the field of public health and to
communicate what public health provides.
 9a. Three Core Functions of Public Health
▪ Systematically collect, analyze, and make available
information on healthy communities to identify needs
Assessment ▪ Monitor health status
▪ Diagnose and investigate health problems

▪ Promote the use of a scientific knowledge base in

Policy policy and decision making to get things done

▪ Inform, educate, empower people about health
Development concerns
▪ Mobilize community partnership
▪ Develop policies and plans

▪ Ensure provision of services to those in need

▪ Enforce laws and regulations
▪ Link to/ provide care
Assurance ▪ Assure a competent public health and personal
healthcare workforce
▪ Evaluate effectiveness
▪ Research into new innovative solutions to health
programs

Institute of Medicine. The future of public health. Washington, DC: National Academies Press; 1988. 32
9b. Ten Essential Public Health Services
1. Monitor Health status
2. Diagnose and Investigate health
problems
3. Inform, Educate, Empower people
about health concerns
4. Mobilize Community Partnership
5. Develop Policies and plans
6. Enforce Laws and regulations
7. Link to/Provide Care
8. Assure a competent public health and
personal healthcare workforce
9. Evaluate effectiveness
10. Research into new innovative
solutions to health programs

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References
• CDC. Public health 101 series. Introduction to
Public Health
• McKenzie JF, Pinger RR & Kotecki JE, 2005. An
introduction to community health 5th Edition. Jones
and Bartlett Publishers, Canada
• Allender JA, Rector C, Warner KD, 2010. Community
& Public Health Nursing – Promoting the Public’s
Health 8th Edition. Wolters Kluwer – Lippincott
Williams & Wilkins, Philadelphia, PA
Thank you!!!